What is the recommended catch-up vaccination schedule for a 6-year-old child with no previous vaccinations in a given location?

Catch-Up Vaccination Schedule for a 6-Year-Old with No Prior Vaccinations

Immediate First Visit - Administer All Age-Appropriate Vaccines Simultaneously

For a 6-year-old child with no vaccination history, administer DTaP, IPV, MMR, Varicella, Hepatitis B, Hepatitis A, and Influenza vaccines simultaneously at the first visit to rapidly establish protection against vaccine-preventable diseases. 1, 2

Vaccines to Give at First Visit

• DTaP (Diphtheria, Tetanus, Pertussis) - First dose of the series 1, 2
• IPV (Inactivated Poliovirus) - First dose 1, 2
• MMR (Measles, Mumps, Rubella) - First dose (this child is significantly overdue, as this is typically given at 12-15 months) 1, 2
• Varicella - First dose 1, 2
• Hepatitis B - First dose 1, 2
• Hepatitis A - First dose 1
• Influenza vaccine - If during flu season, this child will require two doses separated by at least 4 weeks since this is their first time receiving influenza vaccine 1

Critical Vaccines NOT Indicated at This Age

• Hib (Haemophilus influenzae type b) and PCV (Pneumococcal Conjugate) are NOT routinely recommended for healthy children ≥5 years of age unless high-risk medical conditions exist 2
• Rotavirus vaccine is absolutely contraindicated at age 6 years because it must be initiated between 6-14 weeks of age and completed by 8 months due to intussusception risk 1, 2

Follow-Up Schedule with Minimum Intervals

Second Visit (4 Weeks After First Visit)

• DTaP - Second dose (minimum 4 weeks after first dose) 1
• IPV - Second dose (minimum 4 weeks after first dose) 1
• Hepatitis B - Second dose (minimum 4 weeks after first dose) 1
• MMR - Second dose (minimum 4 weeks after first dose) 1, 2
• Influenza - Second dose if during flu season (minimum 4 weeks after first dose for first-time recipients) 1

Third Visit (4 Weeks After Second Visit, 8 Weeks After First Visit)

• DTaP - Third dose (minimum 4 weeks after second dose) 1
• IPV - Third dose (minimum 4 weeks after second dose) 1
• Varicella - Second dose (can be given at 4 weeks for catch-up, though routine interval is 3 months) 1

Fourth Visit (8 Weeks After Third Visit, 16 Weeks After First Visit)

• Hepatitis B - Third dose (must be at least 8 weeks after second dose AND at least 16 weeks after first dose) 1

Fifth Visit (6 Months After Second Visit for Hepatitis A)

• Hepatitis A - Second dose (minimum 6 months after first dose) 1

Sixth Visit (6 Months After Third DTaP Dose AND After Age 4 Years)

• DTaP - Fourth dose (minimum 6 months after third dose AND must be given after age 4 years for final dose) 1, 2
• IPV - Fourth dose as the final dose 1, 2

Essential Principles for Catch-Up Vaccination

• Never restart a vaccine series regardless of time elapsed between doses - simply continue from where the child left off 1, 2
• Minimum intervals must be strictly respected to ensure adequate immune response, but longer-than-recommended intervals do not reduce final antibody concentrations or require additional doses 1
• Multiple vaccines can and should be administered simultaneously at separate anatomic sites when indicated, as this increases the likelihood of complete vaccination and does not negatively affect immune response 1
• Use combination vaccines when available to reduce the number of injections and improve compliance 1

Critical Pitfalls to Avoid

• Do not delay vaccination waiting for "the right time" - start immediately at the first visit 2
• Do not restart the series if doses are delayed - simply continue from where the child left off 1, 2
• Do not give Hib or PCV to healthy children ≥5 years unless high-risk conditions exist 2
• Screen for contraindications before each visit, including severe allergic reactions to vaccine components, immunodeficiency, or moderate-to-severe acute illness 1

Documentation and Ongoing Care

• Document all vaccines carefully to avoid unnecessary repeat doses and ensure proper tracking of the catch-up schedule 1
• Counsel the parent about the importance of maintaining the schedule going forward, as this child is at significantly increased risk for vaccine-preventable diseases until fully caught up 1
• Annual influenza vaccination should continue every year thereafter 1
• Report any clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) 2

Future Adolescent Vaccines (Age 11-12 Years)

• HPV vaccine series - Three doses at 0,2, and 6 months 2
• Tdap booster - Single adolescent/adult formulation dose 3
• MenACWY - First dose at age 11-12 years, with booster at age 16 years 3